Going, Going, Gone The Diminishing Capacity of Museum Specimen Collections to Address Global Change Research: A Case Study on Urban Reptiles

It has been increasingly popular to use natural history specimens to examine environmental changes. As the current functionality of museum specimens has extended beyond their traditional taxonomic role, there has been a renewed focus on the completeness of biological collections to provide data for current and future research. We used the collections of the Western Australian Museum to answer questions about the change in occurrence of five common reptile species due to the rapid urbanization of Perth. We recorded a significant decline in collection effort from the year 2000 onwards (F = 7.65, p < 0.01) compared to the period 1990–1999. Spatial analysis revealed that only 0.5% of our study region was well sampled, 8.5% were moderately sampled and the majority of the regions (91%) were poorly sampled. By analysing the trend of specimen acquisition from 1950 to 2010, we discovered a significant inconsistency in specimen sampling effort for 13 common reptile species across time and space. A large proportion of past specimens lacked information including the place and time of collection. An increase in investment to museums and an increase in geographically and temporally systematic collecting is advocated to ensure that collections can answer questions about environmental change.

Fire in Semi-Arid Shrublands and Woodlands: Spatial and Temporal Patterns in an Australian Landscape

Semi-arid landscapes are of interest to fire ecologists because they are generally located in the climatic transition zone between arid lands (where fires tend to be rare due to lack of fuel, but are enhanced following large rainfall episodes) and more mesic regions (where fire activity tends to be enhanced following severe rainfall deficits). Here we report on the characteristics of the contemporary fire regimes operating in a semi-arid region of inland south-western Australia with rainfall averaging around 300 mm per annum. To characterize fire regimes, we analyzed a geodatabase of fire scars (1960–2018) to derive fire preferences for each major vegetation type and fire episode and used known fire intervals to model fire hazard over time and calculate typical fire frequencies. We also used super epoch analysis and correlations to explore relationships between annual fire extent and rainfall received before the fire. We found fires strongly favored sandplain shrublands, and these tended to experience hot crown fires once every 100 years (median fire interval), with fire hazard increasing linearly over time. In contrast, fires were rare in eucalypt woodland and other vegetation types, with a median interval of 870 years and broadly consistent fire hazard over time. Annual fire extent was most strongly linked with high rainfall in the year prior to fire, and this was particularly so for eucalypt woodlands. Large-scale fires in shrublands tended to favor areas burnt in previous large fires, whereas in woodlands they favored edges. In conclusion, we found divergent fire regimes across the major vegetation types of the region. Sandplain shrublands were similar to Mediterranean shrublands in that they experienced intense stand-replacing wildfires which recovered vigorously although slowly, meaning burnt shrublands did not experience fires again for at least 25 and 100 years on average. In contrast, eucalypt woodlands were fire sensitive (trees readily killed by fire) and experienced fires mostly around the edges, spreading into core areas only after large rainfall events elevated fuel levels. Overall, both vegetation types subscribed to typical arid-zone fire regimes where elevated rainfall, and not drought, promoted fires, although the role of fuel accumulation over time was more important in the shrublands.

Spatial ecology of an endangered carnivore, the Pilbara northern quoll

Understanding the spatial requirements of a species allows one to tailor actions that can help protect species and their habitats. We investigated the spatial needs of the endangered northern quoll (Dasyurus hallucatus) in the Pilbara. We analysed field data based on GPS-telemetry or a combination of GPS and VHF telemetry for 11 northern quolls with data collected over two week periods. Using MCP and Kernel methods, we found average short-term ranges of 193ha and 115ha for males, and for the only female with reliable data the estimates were 34ha and 23ha, respectively, with Kernel-based core areas that were between five and three times smaller for males and the female, respectively. We found support for our hypothesis that ranges differ between seasons, but with a seasonal trend that was different from that expected. The ranges of males during the premating/mating season were smaller than during the pouch-young season. Our study provides the first detailed attempt to define and understand short-term movement behaviour of the Pilbara northern quoll. The information derived from our study can help to increase the accuracy of predictive outputs and better inform habitat prioritisation and conservation management of the Pilbara northern quoll population.

Sensitivity of Clinical Pediatric Obesity Diagnosis Documented in Electronic Health Records

Objective. This study tested the sensitivity of obesity diagnosis in electronic health records (EHRs) using body mass index (BMI) classification and identified variables associated with obesity diagnosis. Methods. Eligible children aged 2 to 18 years had a calculable BMI in 2017 and had at least 1 visit in 2016 and 2017. Sensitivity of clinical obesity diagnosis compared with children's BMI percentile was calculated. Logistic regression was performed to determine variables associated with obesity diagnosis. Results. Analyses included 31 059 children with BMI at or above 95th percentile. Sensitivity of clinical obesity diagnosis was 35.81%. Clinical obesity diagnosis was more likely if the child had a well visit, had Medicaid insurance, was female, Hispanic or Black, had a chronic disease diagnosis, and saw a provider in a practice in an urban area or with academic affiliation. Conclusion. Sensitivity of clinical obesity diagnosis in EHR is low. Clinical obesity diagnosis is associated with nonmodifiable child-specific factors but also modifiable practice-specific factors.

Toxic time bombs: Frequent detection of anticoagulant rodenticides in urban reptiles at multiple trophic levels

Anticoagulant rodenticides (ARs) are regularly used around the world to control pest mammals. Second-generation anticoagulant rodenticides (SGARs) are highly persistent in biological tissue and have a high potential for bioaccumulation and biomagnification. Consequently, exposure and poisoning of non-target organisms has been frequently documented, especially in countries with unregulated AR sales and usage. Most of this research has focussed on rodent-predators, usually raptors and predatory mammals, although exposure has also been documented in invertebrates and insectivorous fauna. Few studies have explored non-target exposure in reptiles, despite species sharing similar trophic positions and dietary preferences to other exposed fauna. We tested three abundant urban reptile species in Perth, Western Australia that differ in diet and trophic tiers for multiple AR exposure, the dugite Pseudonaja affinis (rodent-predator), the bobtail Tiliqua rugosa (omnivore) and the tiger snake Notechis scutatus occidentalis (frog-predator). We found frequent exposure in all three species (91% in dugites, 60% in bobtails and 45% in tiger snakes). Mean combined liver concentrations of ARs of exposed individuals were 0.178 mg/kg in dugites, 0.040 mg/kg in bobtails and 0.009 mg/kg in tiger snakes. High exposure frequency and liver concentration was expected for the dugite. Exposure in the other species is more surprising and implies widespread AR contamination of the food web. We discuss the likelihood of global AR exposure of urban reptiles, highlight the potential for reptiles to be important vectors of ARs in the food web and highlight implications for humans consuming wild reptiles.

The plant natural product 2-methoxy-1,4-naphthoquinone stimulates therapeutic neural repair properties of olfactory ensheathing cells

Olfactory ensheathing cells (OECs) are crucial for promoting the regeneration of the primary olfactory nervous system that occurs throughout life. Transplantation of OECs has emerged as a promising therapy for nervous system injuries, in particular for spinal cord injury repair. Functional outcomes in both animals and humans are, however, highly variable, primarily because it is difficult to rapidly obtain enough OECs for transplantation. Compounds which can stimulate OEC proliferation without changing the phenotype of the cells are therefore highly sought after. Additionally, compounds which can stimulate favourable cell behaviours such as migration and phagocytic activity are desirable. We conducted a medium-throughput screen testing the Davis open access natural product-based library (472 compounds) and subsequently identified the known plant natural product 2-methoxy-1,4-naphthoquinone as a stimulant of OEC viability. We showed that 2-methoxy-1,4-naphthoquinone: (i) strongly stimulates proliferation over several weeks in culture whilst maintaining the OEC phenotype; (ii) stimulates the phagocytic activity of OECs, and (iii) modulates the cell cycle. We also identified the transcription factor Nrf2 as the compound’s potential molecular target. From these extensive investigations we conclude that 2-methoxy-1,4-naphthoquinone may enhance the therapeutic potential of OECs by stimulating proliferation prior to transplantation.

A cluster-based approach for integrating clinical management of Medicare beneficiaries with multiple chronic conditions

Background

Approximately 28% of adults have ≥3 chronic conditions (CCs), accounting for two-thirds of U.S. healthcare costs, and often having suboptimal outcomes. Despite Institute of Medicine recommendations in 2001 to integrate guidelines for multiple CCs, progress is minimal. The vast number of unique combinations of CCs may limit progress.

Methods and findings

To determine whether major CCs segregate differentially in limited groups, electronic health record and Medicare paid claims data were examined in one accountable care organization with 44,645 Medicare beneficiaries continuously enrolled throughout 2015. CCs predicting clinical outcomes were obtained from diagnostic codes. Agglomerative hierarchical clustering defined 13 groups having similar within group patterns of CCs and named for the most common CC. Two groups, congestive heart failure (CHF) and kidney disease (CKD), included 23% of beneficiaries with a very high CC burden (10.5 and 8.1 CCs/beneficiary, respectively). Five groups with 54% of beneficiaries had a high CC burden ranging from 7.1 to 5.9 (descending order: neurological, diabetes, cancer, cardiovascular, chronic pulmonary). Six groups with 23% of beneficiaries had an intermediate-low CC burden ranging from 4.7 to 0.4 (behavioral health, obesity, osteoarthritis, hypertension, hyperlipidemia, ‘other’). Hypertension and hyperlipidemia were common across groups, whereas 80% of CHF segregated to the CHF group, 85% of CKD to CKD and CHF groups, 82% of cancer to Cancer, CHF, and CKD groups, and 85% of neurological disorders to Neuro, CHF, and CKD groups. Behavioral health diagnoses were common only in groups with a high CC burden. The number of CCs/beneficiary explained 36% of the variance (R² = 0.36) in claims paid/beneficiary.

Conclusions

Identifying a limited number of groups with high burdens of CCs that disproportionately drive costs may help inform a practical number of integrated guidelines and resources required for comprehensive management. Cluster informed guideline integration may improve care quality and outcomes, while reducing costs.

Improving Hypertension Control in Primary Care With the Measure Accurately, Act Rapidly, and Partner With Patients Protocol

Supplemental Digital Content is available in the text.

Better blood pressure (BP; mm Hg) control is a pivotal national strategy for preventing cardiovascular events. Measure accurately, Act rapidly, and Partner with patients (MAP) with practice facilitation improved BP control (<140/<90 mm Hg) from 61.2% to 89.8% during a 6-month pilot study in one primary care clinic. Current study objectives included evaluating the 6-month MAP framework in 16 Family Medicine Clinics and then withdrawing practice facilitation and determining whether better hypertension control persisted at 12 months since short-term improvements often decline by 1 year. Measure accurately included staff training in attended (intake) BP measurement and unattended automated office BP when intake BP was ≥140/≥90 mm Hg. Act rapidly (therapeutic inertia) included protocol-guided escalation of antihypertensive medications when office BP was ≥140/≥90 mm Hg. Partner with patients (systolic BP decline/therapeutic intensification) included shared decision making, BP self-monitoring, and affordable medications. Study data were obtained from electronic records. In 16 787 hypertensive adults (mean, 61.2 years; 54.1% women; 46.0% Medicare) with visits at baseline and first 6 months, BP control improved from 64.4% at baseline to 74.3% (P<0.001) at 6 and 73.6% (P<0.001) at 12 months. At the first MAP visit, among adults with uncontrolled baseline BP and no medication changes (n=3654), measure accurately resulted in 11.1/5.1 mm Hg lower BP. During the first 6 months of MAP, therapeutic inertia fell (52.0% versus 49.5%; P=0.01), and systolic BP decreased more per therapeutic intensification (−5.4 to −12.7; P<0.001). MAP supports a key national strategy for cardiovascular disease prevention through rapid and sustained improvement in hypertension control, largely reflecting measuring accurately and partnering with patients.

Anticoagulant rodenticide use, non-target impacts and regulation: A case study from Australia

The impacts of anticoagulant rodenticides (ARs) on non-target wildlife have been well documented in Europe and North America. While these studies are informative, patterns of non-target poisoning of wildlife elsewhere in the world may differ substantially from patterns occurring in Australia and other countries outside of cool temperate regions due to differences in the types of ARs used, patterns of use, legislation governing sales, and potential pathways of secondary exposure. Most of these differences suggest that the extent and severity of AR poisoning in wildlife may be greater in Australia than elsewhere in the world. While many anecdotal accounts of rodenticide toxicity were found - especially in conjunction with government control efforts and island eradications - no published studies have directly tested rodenticide exposure in non-target Australian wildlife in a comprehensive manner. The effects of private and agricultural use of rodenticides on wildlife have not been adequately assessed. Synthesis of reviewed literature suggests that anticoagulant rodenticides may pose previously unrecognised threats to wildlife and indigenous people in Australia and other nations with diverse and abundant reptile faunas relative to countries with cooler climates where most rodenticide ecotoxicology studies have been conducted. To address the identified knowledge gaps we suggest additional research into the role of reptiles as potential AR vectors, potential novel routes of human exposure, and comprehensive monitoring of rodenticide exposure in Australian wildlife, especially threatened and endangered omnivores and carnivores. Additionally, we recommend regulatory action to harmonise Australian management of ARs with existing and developing global norms.

BioTIME: A database of biodiversity time series for the Anthropocene

MOTIVATION

The BioTIME database contains raw data on species identities and abundances in ecological assemblages through time. These data enable users to calculate temporal trends in biodiversity within and amongst assemblages using a broad range of metrics. BioTIME is being developed as a community-led open-source database of biodiversity time series. Our goal is to accelerate and facilitate quantitative analysis of temporal patterns of biodiversity in the Anthropocene.

MAIN TYPES OF VARIABLES INCLUDED

The database contains 8,777,413 species abundance records, from assemblages consistently sampled for a minimum of 2 years, which need not necessarily be consecutive. In addition, the database contains metadata relating to sampling methodology and contextual information about each record.

SPATIAL LOCATION AND GRAIN

BioTIME is a global database of 547,161 unique sampling locations spanning the marine, freshwater and terrestrial realms. Grain size varies across datasets from 0.0000000158 km2 (158 cm2) to 100 km2 (1,000,000,000,000 cm2).

TIME PERIOD AND GRAIN

BioTIME records span from 1874 to 2016. The minimal temporal grain across all datasets in BioTIME is a year.

MAJOR TAXA AND LEVEL OF MEASUREMENT

BioTIME includes data from 44,440 species across the plant and animal kingdoms, ranging from plants, plankton and terrestrial invertebrates to small and large vertebrates.

SOFTWARE FORMAT

.csv and .SQL.

Differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States

The US Preventive Services Task Force cholesterol guideline recommended statins for fewer adults than the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline by setting a higher 10-year atherosclerotic cardiovascular disease threshold (≥10.0% vs ≥7.5%) and requiring concomitant diabetes mellitus, hypertension, dyslipidemia, or cigarette smoking. The 2017 ACC/AHA hypertension guideline lowered the hypertension threshold, increasing 2016 guideline statin-eligible adults. Cross-sectional data on US adults aged 40 to 75 years enabled estimated numbers for the 2013 guideline and 2016 guideline with hypertension thresholds of ≥140/≥90 mm Hg and ≥130/80 mm Hg, respectively, on: (1) untreated, statin-eligible adults for primary atherosclerotic cardiovascular disease prevention (25.40, 14.72, 15.35 million); (2) atherosclerotic cardiovascular disease events prevented annually (124 000, 70 852, 73 199); (3) number needed to treat (21, 21, 21); and (4) number needed to harm (38, 143, 143) per 1000 patient-years for incident diabetes mellitus (42 800, 6700, 7100 cases per year). Despite the lower hypertension threshold, the 2013 cholesterol guideline qualifies approximately 10 million more adults for statins and prevents approximately 50 600 more primary atherosclerotic cardiovascular disease events but induces approximately 35 700 more diabetes mellitus cases annually than the 2016 guideline.

Measure Accurately, Act Rapidly, and Partner With Patients (MAP) improves hypertension control in medically underserved patients: Care Coordination Institute and American Medical Association Hypertension Control Project Pilot Study results

Measure Accurately, Act Rapidly, and Partner With Patients (MAP) is an evidence‐based protocol implemented to improve hypertension control in a clinic for underserved patients (49.9% Medicaid and 50.2% black). Patients with hypertension seen during the year before intervention and with at least one visit during the 6‐month intervention (N = 714) were included. If initial attended blood pressure (BP; standard aneroid manometer) was ≥140/≥90 mm Hg, unattended automated office BP was measured in triplicate and averaged (Measure Accurately) using an Omron HEM‐907XL. When automated office BP was ≥140/≥90 mm Hg, Act Rapidly included intensification of antihypertensive medications, assessed by therapeutic inertia. Partner With Patients included BP self‐monitoring, reducing pill burden, and minimizing medication costs, which was assessed by systolic BP change per therapeutic intensification. Between baseline and the last study visit, BP control to <140/<90 mm Hg increased from 61.2% to 89.9% (P < .0001). MAP rapidly and significantly improved hypertension control in medically underserved patients, largely as a result of measuring BP accurately and partnering with patients.

Cholesterol Control Among Uninsured Adults Did Not Improve From 2001-2004 to 2009-2012 as Disparities With Both Publicly and Privately Insured Adults Doubled

BACKGROUND

Low-density lipoprotein cholesterol (LDL-C) control is higher among insured than uninsured adults, but data on time trends and contributing factors are incomplete and important for improving health equity.

METHODS AND RESULTS

Awareness, treatment, and control of elevated LDL-C were compared among insured versus uninsured and publicly versus privately insured adults, aged 21 to 64 years, in National Health and Nutrition Examination Surveys from 2001 to 2004, 2005 to 2008, and 2009 to 2012 using Adult Treatment Panel-3 criteria. Compared with insured adults, uninsured adults were younger; were more often minority; reported lower incomes, less education, and fewer healthcare encounters; and had lower awareness and treatment of elevated LDL-C (P<0.0001). LDL-C control was higher among insured than uninsured adults in 2001 to 2004 (mean±SEM, 21.4±1.6% versus 10.5±2.6%; P<0.01), and the gap widened by 2009 to 2012 (35.1±1.9% versus 11.3±2.2%; P<0.0001). Despite more minorities (P<0.01), greater poverty, and less education (P<0.001), publicly insured adults had more healthcare visits/year than privately insured adults (P<0.001) and similar awareness, treatment, and control of LDL-C from 2001 to 2012. In multivariable logistic regression, significant positive predictors of cholesterol awareness, treatment, and control included more frequent health care (strongest), increasing age, private healthcare insurance versus uninsured, and hypertension. Public insurance (versus uninsured) was a significant positive predictor of LDL-C control, whereas income <200% versus ≥200% of federal poverty was a significant negative predictor.

CONCLUSIONS

LDL-C control improved similarly over time in publicly and privately insured adults but was stagnant among the uninsured. Healthcare insurance largely addresses socioeconomic barriers to effective LDL-C management, yet poverty retains an independent adverse effect.

Abstract P443: Multiple Chronic Conditions in Older Adults: Implications for Clinical Trials & Guidelines in Hypertension

Background: Multiple chronic conditions ([M]CCs), including hypertension (HTN) and clinical CVD, increase sharply with age and account for most U.S. healthcare costs. In 2001, the Institute of Medicine recommended integrated clinical guidelines for MCC. The dearth of integrated guidelines reflects limited inclusion of complex patients in clinical trials and continued focus on individual diseases.

Methods: To explore implications of MCC for clinical trials and HTN guidelines in older adults, hierarchical clustering was used to segregate beneficiaries in one large Medicare Shared Savings Program into clusters with similar groups of MCC. Clusters were named for the most prevalent CC and described by number of CCs, prevalent HTN, CVD, behavioral health diagnoses and paid claims.

Results: The 50,627 beneficiaries (mean 72 yrs) segregated into 12 clusters; 36,533 (72.2%) had HTN. A total of 33,262 beneficiaries (65.7%) segregated into 6 complex clusters (CHF, CKD, Diabetes, Cancer, COPD, Vascular) with a high prevalence of CVD; 27,324 (82.1%) had HTN. The CHF and CKD clusters had the highest mean number of CCs (9.8, 7.5, respectively), HTN prevalence (94.3%, 91.9%), and yearly costs ($37,700, $26,700/beneficiary). Diabetes, cancer, COPD and vascular disease clusters also had a large burden of CCs (5.9, 5.8, 5.1, 5.4) and HTN (88.3%, 73.6%, 70.7%, 83.9%) with annual healthcare costs from $19,500 (cancer) to $12,900 (COPD); more than 1/3 of patients in the CHF, CKD, diabetes and vascular clusters had a behavioral health diagnosis, most often depression. Of 17,365 (34.3%) beneficiaries in less complex clusters, 9,209 (54%) had HTN, 90+% were candidates for primary CVD prevention, less than 10% had behavioral health diagnoses, and costs were lower.

Conclusions: HTN impacts ~82% of older adults with a higher burden of MCC, and ~75% (27,324/36,533) of Medicare beneficiaries with HTN have a large burden of MCCs. Behavioral health diagnosis, associated with adverse outcomes and costs, are common with MCCs. Clinical care, outcomes and costs for older adults with HTN and MCCs could improve with more representative inclusion in clinical trials and translation through integrated clinical guidelines developed by multi-specialty/disciplinary teams.

Dichloro-naphthoquinone as a non-classical inhibitor of the mycobacterial carbonic anhydrase Rv3588c

The soluble mycobacterial carbonic anhydrases Rv3588c and Rv1284 belong to a different class of carbonic anhydrases than those found in humans, making them attractive drug targets by using the inherent differences in the folds of the different classes. By screening a natural product library, we identified naphthoquinone derivatives as a novel non-classical inhibitor scaffold of mycobacterial carbonic anhydrases that lack the sulfonamide/sulfamate group and thus did not affect human carbonic anhydrase II.

Resilience to agricultural habitat fragmentation in an arboreal marsupial

The impact of habitat fragmentation on arboreal mammals is poorly understood and potentially greater than for ground-dwelling mammals. We investigated the influence of landscape fragmentation on a generalist arboreal marsupial, the koomal (Trichosurus vulpecula hypoleucus), a geographically isolated subspecies of the common brushtail possum endemic to south-western Australia. Since European settlement this taxon has undergone a significant reduction in range and population. We describe a year-long trapping study, incorporating radio-tracking, of a koomal population in a fragmented agricultural landscape to determine how agriculture and habitat fragmentation affect populations. In all, 61 free-ranging individuals were captured. Mark–recapture modelling estimated the population of 28.8 per trapping event with a total population size of 69 individuals having been present in the test landscape during the course of the study. Population demographics were comparable with populations found in relatively continuous landscapes. Mean home-range size was 8.8 ha of remnant vegetation for males and 7.9 ha for females. Home ranges usually incorporated several patches. Utilisation of shrublands, wetlands, and areas infested with Phytophthora dieback was not observed. Individuals required access to a selection of suitable denning trees and distances between patches <100 m did not appear to impair movement, with gaps <400 m regularly crossed.

Aldosterone Antagonists or Renin-Guided Therapy for Treatment-Resistant Hypertension: A Comparative Effectiveness Pilot Study in Primary Care

BACKGROUND

Uncontrolled treatment-resistant hypertension (TRH), i.e., blood pressure (BP, mm Hg) ≥140/≥90mm Hg in and out of office on ≥3 different BP medications at optimal doses, is common and has a poor prognosis. Aldosterone antagonist (AA) and renin-guided therapy (RGT) are effective strategies for improving BP control in TRH but have not been compared.

METHODS

A comparative effectiveness TRH pilot study of AA vs. RGT was conducted in 4 primary care clinics with 2 each randomized to AA or RGT. The primary outcome was change in clinic BP defined by means of 5 automated office BP values. Eighty-nine patients with apparent TRH were screened and 44 met criteria for true TRH.

RESULTS

Baseline characteristics of 20 patients in the AA (70% Black, 45% female, mean age: 57.4 years) and 24 patients in RGT (79% Black, 50% female, 57.8 years) arms were similar with baseline BP 162±5/90±3 vs. 153±3/84±3, respectively, P = 0.11/0.20. BP declined to 144±5/86±4 in AA vs. 132±4/75±3 in RGT, P = 0.07/0.01; BP was controlled to JNC7 (Seventh Joint National Committee Report) goal in 25% vs. 62.5%, respectively, P < 0.01. Although BP changes from baseline, the primary outcome, were not different (-17.6±5.1/-4.0±3.0 AA vs. -20.4±3.8/-9.7±2.0 RGT, P = 0.65/0.10.), more BP medications were added with AA than RGT (+0.9±0.1 vs. +0.4±0.1 per patient, P < 0.01).

CONCLUSIONS

In this TRH pilot study, AA and RGT lowered BP similarly, although fewer additional medications were required with RGT. A larger comparative effectiveness study could establish the utility of these treatment strategies for lowering BP of uncontrolled TRH patients in primary care.

Incorporating Field Studies into Species Distribution and Climate Change Modelling: A Case Study of the Koomal Trichosurus vulpecula hypoleucus (Phalangeridae)

Species distribution models (SDMs) are an effective way of predicting the potential distribution of species and their response to environmental change. Most SDMs apply presence data to a relatively generic set of predictive variables such as climate. However, this weakens the modelling process by overlooking the responses to more cryptic predictive variables. In this paper we demonstrate a means by which data gathered from an intensive animal trapping study can be used to enhance SDMs by combining field data with bioclimatic modelling techniques to determine the future potential distribution for the koomal (Trichosurus vulpecula hypoleucus). The koomal is a geographically isolated subspecies of the common brushtail possum, endemic to south-western Australia. Since European settlement this taxon has undergone a significant reduction in distribution due to its vulnerability to habitat fragmentation, introduced predators and tree/shrub dieback caused by a virulent group of plant pathogens of the genus Phytophthora. An intensive field study found: 1) the home range for the koomal rarely exceeded 1 km in in length at its widest point; 2) areas heavily infested with dieback were not occupied; 3) gap crossing between patches (>400 m) was common behaviour; 4) koomal presence was linked to the extent of suitable vegetation; and 5) where the needs of koomal were met, populations in fragments were demographically similar to those found in contiguous landscapes. We used this information to resolve a more accurate SDM for the koomal than that created from bioclimatic data alone. Specifically, we refined spatial coverages of remnant vegetation and dieback, to develop a set of variables that we combined with selected bioclimatic variables to construct models. We conclude that the utility value of an SDM can be enhanced and given greater resolution by identifying variables that reflect observed, species-specific responses to landscape parameters and incorporating these responses into the model.

Comparative impact of implementing the 2013 or 2014 cholesterol guideline on vascular events in a quality improvement network

OBJECTIVES

The Quality and Care Model Committee for a clinically integrated network requested a comparative analysis on the projected cardiovascular benefits of implementing either the 2013 and 2014 cholesterol guideline in a South Carolina patient population. A secondary request was to assess the relative risk of the two guidelines based on the literature.

METHODS

Electronic health data were obtained on 1,580,860 adults aged 21-80 years who had had one or more visits from January 2013 to June 2015; 566,688 had data to calculate 10-year atherosclerotic cardiovascular disease (ASCVD10) risk. Adults with end-stage renal disease (n = 7852), congestive heart failure (n = 19,818), alcohol or drug abuse (n = 68,547), or currently on statins (n = 154,964) were excluded leaving 315,508 for analysis. Estimated reduction in ASCVD10 assumed that: (a) moderate-intensity statins lowered low-density lipoprotein cholesterol (LDL-C) by 35% and high-intensity statins by 50%; (b) ASCVD events declined 22% for each 1 mmol/l fall in LDL-C.

RESULTS

Among the 315,508 adults in the analysis, 131,289 (41.6%) were eligible for statins according to the 2013 guideline and 137,375 (43.5%) to the 2014 guideline. The 2013 and 2014 guidelines were estimated to prevent 6780 and 5915 ASCVD events over 10 years with: (a) relative risk reductions of 29.0% and 21.8%; (b) absolute risk reductions of 5.2% and 4.3%; (c) number needed-to-treat (NNT) of 19 and 23, respectively. The greater projected cardiovascular protection with the 2013 guideline was largely related to greater use of high-dose statins, which carry a greater risk for adverse events. The literature indicates that the NNT for benefit with high-intensity versus moderate-intensity statins is 31 in high-risk patients with a number needed-to-harm of 47.

CONCLUSIONS

The 2013 guideline is projected to prevent more clinical ASCVD events and with lower NNTs than the 2014 guideline, yet both have substantial benefit. The 2013 guideline is also expected to generate more adverse events, but the risk-benefit profile appears favor .

Impact of Implementing the 2013 ACC/AHA Cholesterol Guidelines on Vascular Events in a Statewide Community-Based Practice Registry

Electronic health record data were analyzed to estimate the number of statin-eligible adults with the 2013 American College of Cardiology/American Heart Association cholesterol guidelines not taking statin therapy and the impact of recommended statin therapy on 10-year atherosclerotic cardiovascular disease (ASCVD10 ) events. Adults aged 21 to 80 years in an outpatient network with ≥1 clinic visit(s) from January 2011 to June 2014 with data to calculate ASCVD10 were eligible. Moderate-intensity statin therapy was assumed to lower low-density lipoprotein cholesterol by 30% and high-intensity therapy was assumed to reduce low-density lipoprotein cholesterol by 50%. ASCVD events were assumed to decline 22% for each 39 mg/dL decline in low-density lipoprotein cholesterol. Among 411,768 adults, 260,434 (63.2%) were not taking statins and 103,478 (39.7%) were eligible for a statin, including 79,069 (76.4%) patients with hypertension. Estimated ASCVD10 events were 18,781 without and 13,328 with statin therapy, a 29.0% relative and 5.3% absolute risk reduction with a number needed to treat of 19. The 2013 cholesterol guidelines are a relatively efficient approach to reducing ASCVD in untreated, statin-eligible adults who often have concomitant hypertension.

Weak genetic structuring suggests historically high genetic connectivity among recently fragmented urban populations of the scincid lizard, Ctenotus fallens

Populations in fragmented urban remnants may be at risk of genetic erosion as a result of reduced gene flow and elevated levels of inbreeding. This may have serious genetic implications for the long-term viability of remnant populations, in addition to the more immediate pressures caused by urbanisation. The population genetic structure of the generalist skink Ctenotus fallens was examined using nine microsatellite markers within and among natural vegetation remnants within a highly fragmented urban matrix in the Perth metropolitan area in Western Australia. These data were compared with samples from a large unfragmented site on the edge of the urban area. Overall, estimates of genetic diversity and inbreeding within all populations were similar and low. Weak genetic differentiation, and a significant association between geographic and genetic distance, suggests historically strong genetic connectivity that decreases with geographic distance. Due to recent fragmentation, and genetic inertia associated with low genetic diversity and large population sizes, it is not possible from these data to infer current genetic connectivity levels. However, the historically high levels of gene flow that our data suggest indicate that a reduction in contemporary connectivity due to fragmentation in C. fallens is likely to result in negative genetic consequences in the longer term.

A critical review of habitat use by feral cats and key directions for future research and management

Feral cats (Felis catus) have a wide global distribution and cause significant damage to native fauna. Reducing their impacts requires an understanding of how they use habitat and which parts of the landscape should be the focus of management. We reviewed 27 experimental and observational studies conducted around the world over the last 35 years that aimed to examine habitat use by feral and unowned cats. Our aims were to: (1) summarise the current body of literature on habitat use by feral and unowned cats in the context of applicable ecological theory (i.e. habitat selection, foraging theory); (2) develop testable hypotheses to help fill important knowledge gaps in the current body of knowledge on this topic; and (3) build a conceptual framework that will guide the activities of researchers and managers in reducing feral cat impacts. We found that feral cats exploit a diverse range of habitats including arid deserts, shrublands and grasslands, fragmented agricultural landscapes, urban areas, glacial valleys, equatorial to sub-Antarctic islands and a range of forest and woodland types. Factors invoked to explain habitat use by cats included prey availability, predation/competition, shelter availability and human resource subsidies, but the strength of evidence used to support these assertions was low, with most studies being observational or correlative. We therefore provide a list of key directions that will assist conservation managers and researchers in better understanding and ameliorating the impact of feral cats at a scale appropriate for useful management and research. Future studies will benefit from employing an experimental approach and collecting data on the relative abundance and activity of prey and other predators. This might include landscape-scale experiments where the densities of predators, prey or competitors are manipulated and then the response in cat habitat use is measured. Effective management of feral cat populations could target high-use areas, such as linear features and structurally complex habitat. Since our review shows often-divergent outcomes in the use of the same habitat components and vegetation types worldwide, local knowledge and active monitoring of management actions is essential when deciding on control programs.

Adapting to suburbia: bird ecology on an urban-bushland interface in Perth, Western Australia

Birds in urban landscapes must contend with fragmented and degraded remnants of native vegetation and their survival may be dependent on factors such as their ability to disperse through and/or utilize the urban matrix. We examined the frequency of occurrence of birds in native bushland in Kings Park, Perth, Western Australia, and in nine adjacent suburban gardens. We quantified dispersal capacity by observing bird crossing frequency and height over a major six-lane road separating the bushland from adjacent gardens. Finally we quantified matrix utilisation by recording foraging behaviour in urban gardens and bushland. Native bushland had a higher species richness than urban gardens (30 versus 17 species) and 18 species were associated more strongly with bushland. Of these 18 species, 61% were never recorded in urban gardens. Gardens were typified by three generalist species, the Singing Honeyeater Lichenostomus virescens and the introduced Laughing Dove Spilopelia senegalensis and Spotted Dove S. chinensis. Three generalist species, the Red Wattlebird Anthochaera carunculata, Rainbow Lorikeet Trichoglossus haematodus, and Brown Honeyeater Lichmera indistincta were equally abundant in all habitats. Four of 18 bird species (Singing Honeyeater Red Wattlebird, Rainbow Lorikeet, and Australian Ringneck Barnardius zonarius) accounted for the majority of road crossing events. Urban gardens provided a rich resource for generalists and urban exploiters, all of which spent significantly more time foraging on nectar in gardens and significantly more time foraging on insects in bushland. We conclude that urban gardens provide habitat for some species that exploit nectar, but most species in bushland, particularly insectivores, do not use gardens. Our results indicate the importance of retaining well-managed bushland for supporting viable urban bird populations.

Government intervention in child rearing: governing infancy

In this essay, Robert Davis argues that much of the moral anxiety currently surrounding children in Europe and North America emerges at ages and stages curiously familiar from traditional Western constructions of childhood. The symbolism of infancy has proven enduringly effective over the last two centuries in associating the earliest years of children's lives with a peculiar prestige and aura. Infancy is then vouchsafed within this symbolism as a state in which all of society's hopes and ideals for the young might somehow be enthusiastically invested, regardless of the complications that can be anticipated in the later, more ambivalent years of childhood and adolescence. According to Davis, the understanding of the concept of infancy associated with the rise of popular education can trace its pedigree to a genuine shift in sensibility that occurred in the middle of the eighteenth century. After exploring the essentially Romantic positions of Johann Heinrich Pestalozzi and Friedrich Fröbel and their relevance to the pattern of reform of early childhood education in the United Kingdom and the United States, Davis also assesses the influence of figures such as Stanley Hall and John Dewey in determining the rationale for modern early childhood education. A central contention of Davis's essay is that the assumptions evident in the theory and practice of Pestalozzi and his followers crystallize a series of tensions in the understanding of infancy and infant education that have haunted early childhood education from the origins of popular schooling in the late eighteenth century down to the policy dilemmas of the present day.

A rapid LC-MS-MS method for the determination of nicotine and cotinine in serum and saliva samples from smokers: validation and comparison with a radioimmunoassay method

The development and validation of a rapid liquid chromatography (LC)-tandem mass spectrometry (MS-MS) method for determination of nicotine and cotinine in smokers' serum is described. The method is based on solid-phase extraction in a 96-well plate format and requires only 100 microL of serum. Using normal-phase chromatography, both analytes elute in less than 1 min, which permits high sample throughput applications. The calibrated range is 2-100 ng/mL nicotine and 20-1,000 ng/mL cotinine. For known samples, recovery is 95-116% for nicotine and 93-94% for cotinine. The method is extended to rat serum and human saliva (cotinine only) using partial validation techniques. When compared with an existing radioimmunoassay method in our laboratory, the LC-MS-MS method gives improved accuracy, precision, and sample throughput.

Population genetic structure of the western spotted frog, Heleioporus albopunctatus (Anura:Myobatrachidae), in a fragmented landscape in south-western Australia

We report on the genetic structuring of populations of a large burrowing frog, Heleioporus albopunctatus, from the central wheatbelt of Western Australia. This region has been highly fragmented by vegetation clearance for agriculture since the early 1900s. Genetic variation at four variable loci in 22 populations was analysed using cellulose acetate electrophoresis. Analysis across all populations showed a moderate, but significant, degree of subdivision (Fst = 0.087 ± 0.049, P < 0.05) and high levels of heterozygosity (H = 0.133, s.e. = 0.084). Several small populations had higher Fst values in pair-wise comparisons. A mantel test revealed no significant relationship between genetic distance and geographic distance (r = –0.136, P = 0.34) and this, combined with data from multidimensional scaling analyses, suggests that geographic isolation of populations is not a significant determinant of genetic structuring. Despite this, the presence of high levels of subdivision as a result of the erosion of genetic diversity indicates that regional persistence may be dependent on the maintenance of metapopulation structures that allow gene flow.

A benzylisoquinoline alkaloid from Doryphora sassafras

Chemical investigation of the Australian rainforest plant Doryphora sassafras has resulted in the isolation of a new natural product, 2-methyl-1-(p-methoxybenzyl)-6,7-methylenedioxyisoquinolinium chloride (1). The iodide salt of compound 1 has previously been synthesized but only partially characterized. This paper reports the full spectroscopic characterization of 1 by MS, IR, UV, and NMR data.

Structural analysis of cDNA encoding thymidylate synthase in hepatic metastases of human colorectal tumors

The enzyme thymidylate synthase (TS) is an important target of 5-fluorouracil (FUra) that is utilized for the treatment of disseminated colorectal cancer. One determinant of clinical response to FUra-based therapy is TS expression. with high levels of expression being predictive of poor response. In the present investigation the levels of immunoreactive TS were analyzed in human colon metastases in the liver (n=l1). The levels of TS ranged from 0.30 to 4.60 pmol TS/g tissue. A good correlation was observed between the levels of immunoreactive TS and TS mRNA (n=6, r=0.69). Of the 11 metastases analyzed, 5 exhibited relatively high levels of TS expression. Two metastases with high TS expression were obtained from patients who received adjuvant therapy with FUra. In 4 metastases with relatively high levels of TS expression, TS gene copy number was analyzed. No evidence for amplification of TS gene sequences was observed. The basis for the high levels of TS expression was examined by structural analysis of TS cDNA. No nucleotide sequence differences were detected in the coding regions of the TS genes from the metastases. Mutations were detected at positions 961 and/or 1031 in the 3'-untranslated regions of the TS gene from the metastases; mutations at these sites were also detected in DNA isolated from normal colon mucosa (n=4) and primary colorectal tumors (n=4). No correlation was observed between TS expression and the nucleotide alterations at these positions. Polymorphism was observed in the 5'-untranslated regions of the TS gene in hepatic metastases (n=6). A general trend was observed between the structure of the 5'-untranslated region of the gene and TS expression.

Increased production of apolipoprotein B-containing lipoproteins in the absence of hyperlipidemia in transgenic mice expressing cholesterol 7alpha-hydroxylase

The finding that expression of a cholesterol 7alpha-hydroxylase (CYP7A1) transgene in cultured rat hepatoma cells caused a coordinate increase in lipogenesis and secretion of apoB-containing lipoproteins led to the hypothesis that hepatic production of apoB-containing lipoproteins may be linked to the expression of CYP7A1 (Wang, S.-L., Du, E., Martin, T. D., and Davis, R. A. (1997) J. Biol. Chem. 272, 19351-19358). To examine this hypothesis in vivo, a transgene encoding CYP7A1 driven by the constitutive liver-specific enhancer of the human apoE gene was expressed in C56BL/6 mice. The expression of CYP7A1 mRNA (20-fold), protein ( approximately 10-fold), and enzyme activity (5-fold) was markedly increased in transgenic mice compared with non-transgenic littermates. The bile acid pool of CYP7A1 transgenic mice was doubled mainly due to increased hydrophobic dihydroxy bile acids. In CYP7A1 transgenic mice, livers contained approximately 3-fold more sterol response element-binding protein-2 mRNA. Hepatic expression of mRNAs encoding lipogenic enzymes (i.e. fatty-acid synthase, acetyl-CoA carboxylase, stearoyl-CoA desaturase, squalene synthase, farnesyl-pyrophosphate synthase, 3-hydroxy-3-methylglutaryl-CoA reductase, and low density lipoprotein receptor) as well as microsomal triglyceride transfer protein were elevated approximately 3-5-fold in transgenic mice. CYP7A1 transgenic mice also displayed a >2-fold increase in hepatic production and secretion of triglyceride-rich apoB-containing lipoproteins. Despite the increased hepatic secretion of apoB-containing lipoproteins in CYP7A1 mice, plasma levels of triglycerides and cholesterol were not significantly increased. These data suggest that the 5-fold increased expression of the low density lipoprotein receptor displayed by the livers of CYP7A1 transgenic mice was sufficient to compensate for the 2-fold increase production of apoB-containing lipoproteins. These findings emphasize the important homeostatic role that CYP7A1 plays in balancing the anabolic lipoprotein assembly/secretion pathway with the cholesterol catabolic bile acid synthetic pathway.

2000 George Lyman Duff Memorial Lecture: atherosclerosis is a liver disease of the heart

The production of apolipoprotein B (apoB)-containing lipoproteins by the liver is regulated by a complex series of processes involving apoB being cotranslationally translocated across the endoplasmic reticulum and assembled into a lipoprotein particle. The translocation of apoB across the endoplasmic reticulum is facilitated by the intraluminal chaperone, microsomal triglyceride transfer protein (MTP). MTP facilitates the translocation and folding of apoB, as well as the addition of lipid to lipid-binding domains (which consist of amphipathic beta sheets and alpha helices). In the absence of MTP or sufficient lipid, apoB exhibits translocation arrest. Thus, apoB translation, translocation, and assembly with lipids to form a core-containing lipoprotein particle occur as concerted processes. Abrogation of >/=1 of these processes diverts apoB into a degradation pathway that is dependent on conjugation with ubiquitin and proteolysis by the proteasome. The nascent core-containing lipoprotein particle that forms within the lumen of the endoplasmic reticulum can be "enlarged" to form a mature very low density lipoprotein particle. Additional studies show that the assembly and secretion of apoB-containing lipoproteins are linked to the cholesterol/bile acid synthetic pathway controlled by cholesterol 7alpha-hydroxylase. Studies in cultured cells and transgenic mice indicate that the expression of cholesterol 7alpha-hydroxylase indirectly regulates the expression of lipogenic enzymes through changes in the cellular content of mature sterol response element binding proteins. Oxysterols and bile acids may also act via the ligand-activated nuclear receptors LXR and FXR to link the metabolic pathways controlling energy balance and lipid metabolism to nutritional state.

Cholesterol and hepatic lipoprotein assembly and secretion

The assembly and secretion of apo B100 containing lipoproteins (i.e., VLDL) by the liver and cholesterol metabolism are interrelated on several different levels and for several different physiologic reasons. Firstly, hepatic VLDL is the major precursor for LDL, which in the human is the major vehicle responsible for transporting cholesterol to peripheral tissues. Secondly, cholesterol is supplied to many tissues by a specific uptake of LDL via LDL receptor, which is expressed in a regulated manner by most mammalian tissues. Thirdly, the rate of hepatic cholesterol biosynthesis and metabolism to bile acids correlates with production of VLDL. This apparent coordinate expression of cholesterol biosynthetic/catabolic enzymes and hepatic VLDL assembly/secretion are mediated at least in part through the sterol response element binding protein (SREBP) transcription factor family. Their gene targets include a plethora of enzymes that regulate glycolysis, energy production, lipogenesis and cholesterol catabolism. Studies of hepatoma cells overexpressing CYP7A1, the rate-limiting enzyme controlling bile acid synthesis, show that as a result of increased mature SREBP1, there is a coordinate induction of lipogenesis and the assembly and secretion of VLDL. These and additional studies show that the bile acid synthetic pathway and the VLDL assembly/secretion pathway are coordinately linked through SREBP-dependent transcription. Based on studies showing that within the liver acinus, the expression of CYP7A1 is mainly in the pericentral region while HMG-CoA reductase is mainly periportal, we propose that a 'metabolic zonal segregation' plays an important role in coordinate regulation of cholesterol and VLDL metabolism. This putative 'metabolic zonal segregation' may provide segregation of metabolic functions which may be mutually antagonistic. For example, there may be physiologic states in which the bile acid synthetic pathway may compete with the VLDL assembly/secretion pathway for a limited amount of cholesterol. Metabolic antagonism (e.g., competition for cholesterol) may be avoided via inducing SREBP-mediated transcription. Adaptation of catabolic hepatocytes to accommodate the expression of VLDL assembly/secretion may occur in response to activation of SREBP-mediated transcription. Support for these is discussed.